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Home My WebLink AboutBuilding Permit #733 - 89 CHRISTIAN WAY 5/9/2007Permit NO: 33 Date Issued: — BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this paize I LOCATION C411t Print PROPERTY�OWNER RQL-ikf Print MAP NO. PARCEL: ZONING DISTRICT: HISTORIC DISTRICT yes na TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg Others: ENT— [I Demolition ❑ Other Septic ❑ Well ax , ❑ Floodplain €"Wettands ❑ Watershed District Water/Sewer OWNER: Name: A(irirP-.G- DESCRIPTION OF WORK TO BE PREFORMED: Please Type or Print Clearly) ctiiG' _ Phone: ,,rr CONTRACTOR Name f�'� '4- -r,-n a r n ItPhone. 2F(- 7a $ -- �r! 14 Address: 9 fL 041116&z-1 � I 1,�;,A?; es,� Mo/vo .. Supervisors Construction Lice sed' S 04ec) 9 Exp. Date: %/19;7/0 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 0-4=1Total Project Cost: $ FEE: $ 3 Check No.: des 7 Receipt No.: d20 / , NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owne)//� 1-1 - -�--* Signature of contractor Location 0,C No. 33 DateU !w TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 2o, >.-) i-: Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION11 COMMENTS HEALTH COMMENTS DATE REJECTED 11 DATE REJECTED DATE REJECTED El DATE APPROVED DATE APPROVED DATE APPROVED El Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street — �� T FIRE DEPARTMENT , T es no Located at 124 Main Street , Fire Department signaturefdate Akql 6 /C COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 EI COrd L -1 0 x. a a DrA0TO EI COrd L -1 . c o m c c ii CCD + O H C vV ` .O 41 VJ r Irv. c O �� ` y • 4%E Q C it XT 0 W W� yam+ dIL u allcm E 0 Cos .m3 4 _ C m� N .3k) Cm O A m�= C c y ea c O Go O 0 O O CL .� O� c 0 cm N gop:== o :o a =_ F-- m a. O LULU O L= col I CA CO2 n m� o- g = w `� O 1"' t �0.. d-*- m 0 O O O Z � CL Cl y 0 C cm I O M E m m 3� Cca CL D a- 0 g C4 a a w W a � U U o . c o m c c ii CCD + O H C vV ` .O 41 VJ r Irv. c O �� ` y • 4%E Q C it XT 0 W W� yam+ dIL u allcm E 0 Cos .m3 4 _ C m� N .3k) Cm O A m�= C c y ea c O Go O 0 O O CL .� O� c 0 cm N gop:== o :o a =_ F-- m a. O LULU O L= col I CA CO2 n m� o- g = w `� O 1"' t �0.. d-*- m 0 O O O Z � CL Cl y 0 C cm I O M E m m 3� Cca CL D a- 0 g I UJ/ 2UU6 15: 39 RightFax 7813584022 PETERSON -ACCOUNTING PAGE 02 10/3/Z006 3:28 PM PAGE 2/003 Fax 3arYGx ..,I_� .M,. . ACl7RD,M. CERTIFICATE OF LIABILITY INSURANCE M'°°"I,YY' 08 ,PRaDUCPR THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION USI Ina Services of MA, Inc, ONLY AND CONFERS NO RIGHTS UPON THE CORTIFICATR .12 Gill Street Suite $500 HOLDER. THIS CERTIFICATE DOES NOT AMEND, I?XTEND OR PO Box 4043 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. LIM1Ta Woburn, MA 01888.4043 INSURERS AFFORDING COVERAGE NAICV INsuaeD Peterson Party Center. Inc. INRIRFRAi St. Paul Fire and Marina Insurance 24767 INSURERS! North River Insurance Ca. 99999 Swanton Streetnchester, mrc INsURBRc Commerce & Industry Insurance Compan 19410 W 'Wi MA 01890.1918 INSURER D: INSURER E: THi: POLICIPS OF INSURAN It I.ISTED BEI.OW PIAVE BEEN ISSUED TO TNF INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN Y REQUIREMENT, TERM OR CONDITION OF ANY CCN7RACTOR OTHER DOCUMENT MIH REF.PFOTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAYPCRTAIN, TH[ INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SWJECr TO AI,I. T1tE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLIO E& AGGREGATE• LM ITS SIiOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, MR LMR nuaL s TYPE OFINSURANOE a PO-ICYRUMBER DA LIM1Ta A GENERAL LIABILITY CK002IT138 10103106 10103107 PAO4 OCCURRENCE 31000 000 X C(WMFRr:uu.OFJOERALLIAi1LITY � CI.AIMS MNJE Cz OCCUR Mrd E)POIs, r, $5000 PERSONAL A ADV OVURYT7: Si QOD OQD WN2R& AGG REGA7E $2,000,00 GENL AGGREGATE LIMIT AFT -LIES PM: rFROOUCTS - comp/DP AGG s2,000,000 _ POLICY .rIFRC7 MLOC A AUTOMOBn.E LIABILITY MA00200291 10!03106 10103107 ANYAUTO CR1MIUNFD BINOLe LIMIT (EXAraYmnl) 31,oa0000 ALL OA'NED AUTOR btO1LYNNJURY S X R04MULE0 AUTOS "p -e—) X HIRED ArrEn, X BODILY INJURY S -v Nf}l.C1YYN57 AUTfK f a6flam l) PRCPe TY DAMAGE _ CJIRACELIARILITY AITOONLY-EAACGIDENT S LBAu10GNLY: ANY AUTO DTM2R TeIMI FJ\ACC S AGO $ EXCES&UMDRELLA LIAe117Y 5530892346 10103106 10/03/07 EAO4 OCCURRENCE 35,0G0,()00____ X OrCUR a CLAMS MADE ASCFRFfIATE $5,000.000 1 0FDUU1IB1_E S - X RFIENnaI 1Q OQQ C WOwcrlRSCOM1'eNSA11014AND BINDERWC9687289 10109186 10109107 ; X YYGATATu• vtW- EMPLOYF-R.TLIARILITY - -A E.L. EACH Af.X1pENT 3SOD 6t1O ANY PROPRIETOP/PAR7NEREE]lEOJTIVE _ f,FFlCERM!<rMBEREX(IUDED7 11 AAvnR,rt IIr1AfV EL.DIBEABE-EArMPLOYL-T $500.000 El. DISEASE - POLICY LIMIT 400 000 f'RLA/19 Cod's 1miaP OTHER OEBLFp710N OP OPEON RATIONA 1 LOCATIONS/ VEM=31"CLURIONS ADDED 9Y ENDOr1RPPAP.NT 7 W'EOAL PROIII9CNS RE- Infalred's operations renting equipment for business & social functions, including erecting tents. SHOULD ANY OF THC ABOVE DE8CM8rD POLICIES DE CANCKLFb BEFORE THE EXPIRATION Peterson Party Center DATE THEREOF, THP MSUINGINSURER IIrLLMEAVORTOM4Ul ]D� DATswRITPIN 139 Swanton Street NOTICE TO THE CP.RnFlCATE HOLDER NAMED TO THR LEFT, BUT FAILURD TO 00 SD WfALL Winchester, MA 01890 IUPORF NO ORLIpATION OR LIARILITY OF ANY XINLI UPON THE INSURER, ITS AGENTS OR _-,--•,••��i , UT c AGDCD 0 ACORD CORPORATION 1088 ✓f2� �O�!!l/iJlf✓lZl!/E'Q�12O�v'��Cll.��iZlC6P.�6 Board of Building Regulations and Standards Construction Supervisor License License: CS 60219 Birthdate: 4/27/1954 Expiration: 4/27/2009 Tr# 11766 Restriction: 00 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Commissioner The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ll i A Please Print Legibl, Name (Business/Organization/Individual): I )e Address: / 5Z City/State/Zip: Ail V) 9 J � ' Phone #: Are jou an employer? Check the appropriate box: 1--C§"I'employer with /6-2) 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. 0 Building addition 10.0 Electrical repairs or additions 11. [J Plumbing repairs or additions 12.❑ Roof repairs 13.q Other / Z *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic Job Site Expiration City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a - fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investieations of the DIA for insurance coverage verification. I do hereby certifyp)ger the pains anypenalties ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: eci m 9 _w Q }� o] a� 0 = Z U) 0 u L Z J Ci z O J w z a oZ w w 7- Cc 0_ zo � w W m xx ~ U O w ,J)o W " wF cr U C F- o U O LL M =) a a z g w C 0 0 c .- cs E J a) 0 D m 0 U. E m0 ++ (► ZJ C) z U) w U) Z) ° Z .iw Q Iz C:w a, F- J r V) c LT - cc cc Q) E ro LL O cO O CO_ G V � � Q a �cU L O ^ � � r .3 �o 3a U. o y vZ OM � L � L 'O X I Ui L O 1 L OO..' c " In _O 0CN ccU Co O O i - co U CLCD a aI I 3 cc 3 i M o U C O N Ej a) N o j L cCtl o X �I °L z 0 LL E cn N C O l E W ¢�z .0 O0ULomi A., C0 :.�•p=01 o o �L>0a) c I� �3 La�n.aEi i W Va Ux O L a- 3 F-- ° au�- m 0 U. E m0 ++ (► ZJ C) z U) w U) Z) ° Z .iw Q Iz C:w a, F- J r V) c LT - cc cc Q) E ro LL O